Provider Demographics
NPI:1376745786
Name:WINTER, FRED JOSEPH (DMD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:JOSEPH
Last Name:WINTER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ELM CT
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-1311
Mailing Address - Country:US
Mailing Address - Phone:732-548-4172
Mailing Address - Fax:732-548-0306
Practice Address - Street 1:1 ELM CT
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-1311
Practice Address - Country:US
Practice Address - Phone:732-548-4172
Practice Address - Fax:732-548-0306
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D101088800122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist